Analysis of data from 18 low- and lower-middle-income countries revealed widespread disruptions in healthcare utilization during the pandemic and projected corresponding increases in infant and maternal mortality


The decline in the use of essential health care during the COVID-19 pandemic in low- and lower-middle-income countries is having a devastating impact on the health of women and children, according to a new study published August 30 in the open access journal OLP Medicine by Tashrik Ahmed of the World Bank, USA, and colleagues. In some of the world’s poorest countries, projected corresponding increases in child and maternal mortality can erase years of progress and cause thousands of preventable deaths.

Pandemics can affect the use of health services in many ways. These include limitations in infrastructure, healthcare personnel and supply chains, as well as altered patient behavior that can be attributed to changes in public transport, mobility restrictions and fear of to contract a disease. Early studies of the COVID-19 pandemic predicted that these service disruptions posed a threat to non-COVID health service delivery.

In the new study, researchers used service utilization data from 18 countries in Africa and the Middle East to estimate the percentage change in health services provided between March 2020 and June 2021, compared to levels pre-pandemic. Across countries, they found an average decline in outpatient visits of 13.1% and average declines of 2.6% to 4.6% for mother and child services. The biggest service interruptions occurred at the start of the pandemic and for months with strict mobility restrictions. Using a mathematical model, the group projected corresponding increases of 3.6% in child mortality and 1.5% in maternal mortality.

“This work demonstrates how the COVID-19 pandemic has reversed years of progress in the health of women and children, especially those in the most vulnerable communities,” says Dr Ahmed. “As countries face multiple crises that continue to constrain service delivery and use, these findings can help them promote effective policies to strengthen health systems and recover with greater resilience.”

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